MEDICARE: WAYNE E RICHENBACHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	29203	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11910	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1144213356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE E RICHENBACHER MD

Provider Business Mailing Address
First Line	:	PO BOX 2027
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52244-2027
Country	:	US
Telephone Number	:	319-339-3541
Fax Number	:	319-358-2737

Provider Business Practice Location Address
First Line	:	540 E JEFFERSON ST
Second Line	:	SUITE 401
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2477
Country	:	US
Telephone Number	:	319-688-7733
Fax Number	:	319-688-7734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/24/2012

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Directions to “ WAYNE E RICHENBACHER MD” Practice Location

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